Senior doctors are charging NHS premium rates for overtime as pressure to cut waiting lists allows some to earn more than £200,000 a year from extra work, a BBC News investigation has found.

This is almost double the average basic salary of a full-time consultant in England.

Many of the highest-earning consultants are considered part-time, allowing them to work significant amounts of overtime at rates in excess of £200 an hour – four times the normal salary.

NHS England said hospitals would have to offer rates that are competitive with the private sector.

But the British Medical Association (BMA), the doctors’ union, said the NHS would not have to rely so heavily on overtime if there were no staff shortages.

And hospitals said strike days and sick cover were also a factor.

The findings come as the government is investing more money to increase the number of appointments and operations in the NHS – a key election promise made by Labour.

As part of the Budget, the Chancellor said the NHS will receive an extra £25 billion this year and next – with reducing waiting times a priority.

A key part of Labor’s plan is to have staff work evenings and weekends to cut the backlog.

But a BBC News investigation raises concerns about whether this approach can deliver value for money.

A senior NHS source said: “The advisers hold all the cards – they know we can’t make progress on the backlog without them.”

The source said the consultants were in a “quite unique situation compared to other staff” because their contracts meant they could opt out of weekend work and then be charged whatever their hospital was willing to pay for overtime. Could have taken.

He said it was not in the BMA’s interests to renegotiate these “outdated” contracts, more than 20 years old.

“I am concerned that overtime costs are increasing with the need to deal with the backlog and that this will lead to resentment among other NHS staff who often work overtime for slightly longer periods of time,” the source said.

He said the NHS needed to hire more consultants, ask other staff to take on some of their work and invest in technologies such as artificial intelligence to lighten the burden.

BBC News used Freedom of Information requests to hospital trusts and data provided by NHS England to reveal how much consultants working beyond their contracted hours was costing the NHS:

• The total overtime bill is set to reach almost £1 billion in 2023-24, up from £512 million 10 years ago, although some of this increase is related to employing more consultants
• Six in 10 consultants work more than their contracted hours, with the average extra pay being £27,000 a year.
• At least half of the 41 hospital trusts that responded to BBC News are now paying some of their consultants more than £100,000 in overtime.

In 2023–24, Bradford Teaching Hospitals NHS Foundation Trust paid more than £100,000 in overtime payments to four consultants in its medicine speciality.

One man earned just over £208,000 in overtime for 128 days’ work.

And during those shifts, their pay averaged £188 an hour.

The trust said, “similar to most NHS trusts”, it had to rely on overtime pay “to manage waiting lists and cover rota gaps and vacancies” and that covering strikes had placed it under additional stress. .

Medway NHS Foundation Trust confirmed it had paid more than £150,000 in overtime to three radiologists, who diagnose and treat patients using scans and tests – one of whom had earned more than £200,000.

It said deficiencies in this area meant it had to pay premium rates, sometimes on a scan-by-scan basis.

The NHS Frimley Health Foundation Trust paid two consultants in its endoscopy department, which provides internal investigations to deal with the backlog in treatment, more than £180,000 each in overtime.

The trust said: “We are focused on ensuring we always provide value for money – and that everything we spend is proportionate to the benefit to our patients.”

The NHS Humber Health Partnership, which runs five hospitals, paid three consultants between £185,000 and £240,000 in overtime.

Chief medical officer Kate Wood said the overtime spending helped raise money for extra operations over the weekend, reducing waiting lists.

“We assess the cost of these changes based on the risks of not being covered,” he said.

“We have put patient safety first as that is our main focus.

“This is not something that is unique to us.”

Worcestershire Acute Hospitals NHS Trust paid three consultants more than £100,000 in overtime, including one consultant who earned just over £198,000.

Managing director Stephen Coleman said the trust is trying to reduce “premium payments” where possible, but needs to cover sickness absence and vacancies to “run services safely and effectively”. , it has no option.

Some hospitals said overtime rates had increased last year due to the particularly high rates the BMA asked its consultants to provide strike cover for.

“It created a new expectation about what they should get,” one official said.

But BMA advisory co-leaders Dr Helen Neri and Dr Shanu Dutta said: “Unfortunately, the decline in the workforce in the crisis and increasing patient demand – which is causing waiting lists to skyrocket – means that there will be less time to get the job done. It is necessary to work extra hours. ,

He explained that most of the overtime was done during anti-social hours, adding that these were “highly trained and experienced professionals”, so it was fair for them to value their time “at reasonable rates”.

Danny Mortimer of NHS Employers, which represents hospitals on employment issues, said: “In view of the difficult financial position of the NHS, health leaders are trying to reduce extra-contract premium payment rates.”

But there was no easy solution as consultants played a “key role” in tackling the waiting list.

And an NHS England official said the use of agencies, which can be even more expensive, is falling.